Background Graft versus host disease (GVHD) after orthotopic liver transplantation (OLT) is a rare but lethal complication. Early diagnosis and treatment is critical for a better prognosis, but it is often delayed due to nonspecific clinical symptoms and histopathologic manifestations. Detecting and monitoring chimerism for patients suspected of GVHD helps establish a definite diagnosis, but the methods differ in methodology and criteria, which may cause inconsistent or even contradictory conclusions.

Methods A 65-year-old male received OLT from a cardiac death donor with an uneventful immediate posttransplant course. He presented skin rashes on postoperative day (POD) 25, and gradually developed fever, diarrhea and pancytopenia. GVHD was suspected and biopsy of skin rashes were examined. Meanwhile, specimens of peripheral blood and skin rashes were analyzed with insertion-deletion polymorphisms (InDels) to detect and monitor chimerism.

Results Two donor specific markers (N5-1, N11-2) were screened out as “fingerprinting” to quantify the chimerism with InDels analysis. The mean rate of chimerism in peripheral blood was 1.82% (1.34% detected by N5-1, 2.30% detected by N11-2), and 6.34% in skin tissue (3.27% detected by N5-1, 9.41% detected by N11-2) on POD 31. The diagnosis of GVHD was confirmed together with the supportive biopsy results. Treatments including drug withdraw (tacrolimus and mycophenolate mofetil), administration of methylprednisolone, Basiliximab and anti-infection drugs were given, and the patient relieved gradually. The follow-up chimerism test on POD 58 in peripheral blood was 0.007% (0.009% detected by N5-1, 0.005% detected by N11-2).

Conclusions Detecting and monitoring chimerism in patients with typical symptoms and supportive biopsy results is critical to make a definite diagnosis of GVHD after OLT. The technique of InDels analysis suggests a sensitive, feasible and reliable method for detecting and monitoring chimerism, and provides timely results in clinic. It may be helpful for an early definitive diagnosis, and allow for more effective treatments to this lethal disease.

CITATION INFORMATION: Peng B, Liu H, Cheng K, Zhao Y, She X, Niu Y, Zhuang Q, Ming Y. A Novel Method for Detecting and Monitoring Chimerism in Patients with Graft versus Host Disease After Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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